Mehdi Balakhani, D.D.S., M.D., F.A.C.S. is Chief of Plastic and Reconstructive Surgery at Christiana Care Systems and Director of Plastic and Reconstructive Surgery at St. Francis Hospital, Wilmington, Delaware. He has been selected by nurses and his peers as a top doctor in Delaware since 1992. Dr. Balakhani is Board Certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery since 1983. He has contributed more than 20 cosmetic surgery instructional exhibits to the Medical Society of Delaware over the past 20 years. He has provided more than 200 educational seminars for public education in the field of cosmetic and reconstructive surgery.

Deciding on a plastic surgeon to perform your procedure is an important decision. It is essential that you feel confident that you are making the right choice. We have provided testimonials of plastic surgery patients that have placed their trust in Dr. Balakhani to perform their procedures.

"Dear Dr. Balakhani,
It's difficult to adequately express my gratitude to you for all that you have done for me. I am delighted with the results of my surgery. I cannot thank you enough.

What to expect during your consultation

The success and safety of your gynecomastia procedure depends very much on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and lifestyle.

Be prepared to discuss:

Why you want the surgery, your expectations and desired outcome

Medical conditions, drug allergies and medical treatments

Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs including steroids

Previous surgeries

Your surgeon may also:

Evaluate your general health status and any pre-existing health conditions or risk factors

Perform diagnostic testing to determine the underlying cause of gynecomastia; this may include testing of your endocrine function

Examine your breasts and may take detailed measurements of their size and shape, skin quality, placement of your nipples and areolas

Take photographs for your medical record

Discuss your options and recommend a course of treatment

Discuss the likely outcomes of gynecomastia correction and any risks or potential complications

Preparing for surgery

Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding

Special instructions you receive will cover:

What to do on the day of surgery

Post-operative care and follow-up

Your plastic surgeon will also discuss where your procedure will be performed. Breast reduction surgery may be performed in an accredited office-based surgical center, outpatient/ambulatory surgical center, or a hospital.

You’ll need help

If your gynecomastia surgery is performed on an outpatient basis, be sure to arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery.

Procedural Steps:

Plastic surgery to correct gynecomastia is technically called reduction mammaplasty, and reduces breast size, flattening and enhancing the chest contours.

In severe cases of gynecomastia, the weight of excess breast tissue may cause the breasts to sag and stretch the areola (the dark skin surrounding the nipple). In these cases the position and size of the areola can be surgically improved and excess skin may be reduced.

Anesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Liposuction: In cases where gynecomastia is primarily the result of excess fatty tissue, liposuction techniques alone may be used.

This requires insertion of a cannula, a thin hollow tube, through several small incisions. The cannula is moved back and forth in a controlled motion to loosen the excess fat, which is then removed from the body by vacuum suction.

There are various liposuction techniques that may be used; the technique most appropriate in your case will be defined prior to your procedure.

Excision: Excision techniques are recommended where glandular breast tissue or excess skin must be removed to correct gynecomastia.

Excision also is necessary if the areola will be reduced, or the nipple repositioned to a more natural male contour. Incision patterns vary depending on the specific conditions and surgical preference.

Sometimes gynecomastia is treated with both liposuction and excision.

Will there be scars?

Any surgical treatment to correct gynecomastia will require incisions. While most incision lines are concealed within natural contours, some may be visible and are a necessary result of breast reduction surgery.

Where will my surgery be performed?
Surgery to correct gynecomastia may be performed on an outpatient basis, in an office-based or ambulatory surgical facility, or a hospital setting. It may be performed under general anesthesia or local anesthesia with sedation.

These decisions will be based on the requirements of your specific procedure and in consideration of your preference and your doctor’s best judgment. Your plastic surgeon and the assisting staff will fully attend to your comfort and safety.When you go home
If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment.

The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure. Another surgery may be necessary:

To perform additional tightening or repositioning of the breasts

To treat any complications that may occur

Be careful

Following your physician’s instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.

Be sure to ask questions: It’s important that you address all your questions directly with your plastic surgeon. It’s natural to feel some anxiety, whether excitement for the anticipated outcomes or preoperative stress. Discuss these feelings with your plastic surgeon.

My recovery

After surgery, dressings or bandages will be applied to your incisions and an elastic bandage or support garment may be used to minimize swelling and support your new chest contour as it heals.

A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid that may collect.

You will be given specific instructions that may include: How to care for your surgical site(s) following surgery, medications to apply or take orally to aid healing and reduce the risk of infection, specific concerns to look for at the surgical site or in your general health, and when to follow up with your plastic surgeon.

It’s very important to follow your plastic surgeon’s instructions and attend follow-up visits as scheduled.

The results will be long-lasting

The final results of breast reduction in men are permanent in many cases.

However, if gynecomastia resulted from the use of certain prescription medications, drugs including steroids or weight gain you must be fully free from these substances and remain at a stable weight in order to maintain your results. Please discuss this with your physician before making changes to your prescription medications.

All scars are permanent, even though some scars may be concealed in the natural contours of the breast. Your improved upper body will likely enhance your self-image and confidence, whether in a shirt and tie, a t-shirt, or baring your chest at the beach.

How much will gynecomastia surgery cost?

Cost is always a consideration in elective surgery. Prices for gynecomastia can vary widely. A surgeon’s cost for gynecomastia may vary based on his or her experience as well as geographic location.

Many plastic surgeons offer patient financing plans, so be sure to ask.Cost may include:

Surgeon’s fee

Hospital or surgical facility costs

Anesthesia fees

Prescriptions for medication

Post-surgery garments, and

Medical tests

In most cases, correction of gynecomastia is not eligible for insurance coverage. Each insurance policy varies greatly. Carefully review your policy to determine coverage. The American Society of Plastic Surgeons has published a position paper for physicians and insurers defining the recommended criteria for reconstructive cases of gynecomastia. Ask your physician for a copy of this document to submit to your insurer.

Your satisfaction involves more than a fee

When choosing a plastic surgeon for gynecomastia surgery, remember that the surgeon’s experience and your comfort with him or her are just as important as the final cost of the surgery.

Words to know

Areola: Pigmented skin surrounding the nipple.

Bilateral gynecomastia: A condition of over-developed or enlarged breasts in men affecting both breasts.

Endocrine system: A group of glands that make hormones which help to control activities in your body such as reproduction, metabolism, growth and development. Testing of your endocrine system may be done to look for signs of diabetes, thyroid disorders, growth hormone deficiency, osteoporosis, hypertension and obesity.

Excision: To remove the skin.

General anesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness.

Hematoma: Blood pooling beneath the skin.

Intravenous sedation: Sedatives administered by injection into a vein to help you relax.

Liposuction: Also called lipoplasty or suction lipectomy, this procedure vacuums out fat from beneath the skin’s surface to reduce fullness.

Local anesthesia: A drug injected directly to the site of an incision during an operation to relieve pain.

Reduction mammaplasty: The surgical removal of breast tissue to reduce the size of breasts.

Sutures: Stitches used by surgeons to hold skin and tissue together.

Unilateral gynecomastia: A condition of over-developed or enlarged breasts in men affecting just one breast.